Why Universal Healthcare Doesn’t Always Mean Equal Access

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means” – Aneurin Bevan.

In the 71 years since its conception, the National Health Service, arguably the foundation of the United Kingdom’s welfare state, has been a pawn within party politics. The resulting impact, especially over the last decade of Conservative majority rule, has left the least affluent and more vulnerable members of our society out in the cold again.

It is very easy to remove discussions of healthcare and access to these services when referring to social mobility, especially in the United Kingdom when these services are *mostly* free. It is very easy to view healthcare in terms of economic policies and budget deficits, detaching it from people altogether. It is very easy to forget that geographical situations and its corresponding socioeconomic status have a bearing on a patient’s ability to access certain healthcare services and note how this affects overall health outcomes.

In 2012, the green budget for the Institute of Fiscal Studies found that areas with the highest levels of deprivation in England were facing the biggest cuts to local authority spending (which covers a wide range of health and social care services), with some areas facing cuts of up to 30%. Unfortunately, due to the continuation of Conservative austerity economic policy this is a trend which has increased, and our so-called universal healthcare system is facing more economic attacks, with the poorest suffering the most. Whilst I am aware that I am privileged enough to live somewhere which offers free health and social care for the most part (excluding dental care and prescriptions), the fact that our own government is covering up their disdain for those who rely the most on these services under the pretence of economic growth and that it will somehow benefit us in the long term is deeply concerning.

It’s concerning because over the period from 2010 to 2016, over 60 towns and cities had vital hospital services either been shut down or severely downgraded (limited inflexible opening hours, reduction in staff etc) and this has increased since. These have mainly been either Accident and Emergency services, meaning many people will have to travel further for medical attention which in the case of many emergencies can severely affect a patient’s outcome of survival or a return to full health, or maternity units – a blatant attack on reproductive health services.

It’s important to note that due to these funding restrictions in which NHS services have been downgraded, that a disproportionate number of the patients who accessed and relied on these services are those who already deemed our most vulnerable and already at an economic disadvantage, such as those who have experienced homelessness, are part of the traveller community, or experience severe disabilities. Whilst the NHS attempts to adapt to financial restraints as part of its universal nature, such as offering prescription cost exemptions for those in receipt of certain benefits, in the long run economically disadvantaged citizens are still more likely to experience the worst outcomes in regards to their health when compared to their more affluent counterparts.

Therefore, it cannot be called an equal system whereupon people living in areas with high levels of socioeconomic deprivation have lower life expectancies, and that their lives in terms of health and wellbeing (both physically and mentally) are more likely to be of a lower quality. It cannot equate to equal access when the ratio of patients to doctors in general practices can be up to 3 times higher in areas with high socioeconomic deprivation than those places which experience less deprivation. Waiting times for appointments are longer, hours are more inflexible, and overall those patients are less likely to seek medical attention and receive a diagnosis until it is often too late.

I hardly think that this is the vision of universal healthcare many of us have in mind. Healthcare should never discriminate, albeit inadvertently, based on class or household income, or based on the geography of patients. Article 25 of the Universal Declaration of Human Rights states that ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including…sickness and disability’. When healthcare access builds up so many barriers to the most vulnerable, the ones who rely on state funded services the most, then it acts as a barrier to social mobility and continues to perpetuate economic inequalities already so entrenched in our daily lives.

To address these problems, intensified by economic austerity and political partisanship, the NHS needs better and more comprehensive funding alongside social reform – not empty promises pasted onto big red buses. The NHS is the foundation of social security and to continue to cut its funding means to cut the life support of many already struggling communities. That isn’t universality, it is state supported exclusivity and the dire consequences are already being felt.